Manejo y seguimiento radiológico del paciente post-COVID-19

Abstract

La mayor parte de los pacientes que superan la infección por SARS-CoV-2 no presentan complicaciones ni requieren un seguimiento específico, pero una proporción significativa (especialmente aquellos con formas clínicas moderadas/graves de la enfermedad) necesitan un seguimiento clínico-radiológico. Aunque apenas existen referencias o guías clínicas sobre el seguimiento a largo plazo de estos pacientes post-COVID-19, se están realizando pruebas radiológicas y constituyendo consultas monográficas de vigilancia en la mayor parte de los centros hospitalarios para atender sus necesidades. El propósito de este trabajo es compartir nuestra experiencia en el manejo del paciente post-COVID-19 en dos instituciones que han tenido una elevada incidencia de la COVID-19 y proponer unas recomendaciones generales de seguimiento desde una perspectiva clínica y radiológica.

Loss of mitochondrial membrane potential (ΔΨm) in leucocytes as post-COVID-19 sequelae

“… 2 , 17 , 18 , 19 However, the results of the present study suggest that the Δ Ψ m could also be an early indicator of multiple COVID‐19‐associated diseases, since, in recovered patients (without comorbidities with a mean time of SARS‐CoV‐2 infection of 40 ± 13 dai) of COVID‐19 present loss of mitochondrial membrane potential, a phenomenon that persisted 11 months (335 ± 20 days) after COVID‐19 infection. In this regard, some authors have reported that patients who manage to survive the effects of acute SARS‐CoV‐2 infection may develop long‐term sequelae, such as lung injury (pulmonary fibrosis), neuronal injury (acute and chronic neuropathology), and neurodegenerative diseases (Alzheimer's, Parkinson's and multiple sclerosis), 14 , 15 , 16 , 29 , 30 which could be attributed to mitochondrial dysfunction associated to SARS‐CoV‐2 infection, since it has been suggested that mitochondrial dysfunction in conjunction with an abnormal innate immunity response plays a pivotal role in the onset and development of several chronic diseases. 25 , 26 , 27 , 30 , 31 , 32 , 33…”

“… 2 , 10 , 11 , 12 , 13 Patients recovering from acute SARS‐CoV‐2 infection can develop long‐term sequelae, such as lung injury (pulmonary fibrosis) and other inflammatory affections, including neurodegenerative events. 14 , 15 , 16 Thus, mitochondrial integrity is essential to maintain an adequate immune response against SARS‐CoV‐2 infection. 9 , 17 …”

“…Currently, there is information on the effects of SARS‐CoV‐2 on functional parameters of mitochondria in patients with active COVID‐19 12 , 13 , 14 , 15 , 16 , 17 , 18 ; however, there is no information on post‐COVID effects on mitochondrial functionality. Therefore, the present research aimed to evaluate Δ Ψ m in human PBMCs (HPBMCs) in patients with COVID‐19 (C‐19), subjects recently recovered from COVID‐19 (R1) at 40 ± 13 days after infection (dai) and recovered subjects at 11 months postinfection (R2, at 335 ± 20 dai), as well as healthy control (HC) subjects.…”

Effect of Fucoidan on the Mitochondrial Membrane Potential (ΔΨm) of Leukocytes from Patients with Active COVID-19 and Subjects That Recovered from SARS-CoV-2 Infection

“…In the case of patients recovering from acute SARS-CoV-2 infection, they may develop long-term sequelae (pulmonary injury, inflammatory, neurodegenerative, etc.) caused by mitochondrial dysfunction [27][28][29][30][31][32][33][34]. Therefore, the search for alternative treatments is essential to reintegrate cellular homeostasis in SARS-CoV-2 infected subjects.…”

18 Months Computed Tomography Follow-Up after Covid-19 Interstitial Pneumonia

“…It is not clear the role of the virus itself and adjuvants factors such as over-infections, far-toxicities, or mechanical ventilation. 9 Nowadays very little is known about the long-term outcome of Covid-19 infection, in particular about the permanent fibrotic changes that the virus may induce in the lung. Due to the high number of affected patients, understanding the longer-term implications is critical.…”